<html>
  <body>
    <img src="pic_test.php" alt="black block"/>
    <form action="action.php" method="post">
      <p>Your name: <input type="text" name="name"/></p>
      <p>Your age: <input type="text" name="age"/></p>
      <p><input type="submit"/></p>
    </form>
  </body>
</html>

